A response to the Vatican

The Sisters of Charity were founded in Dublin, Ireland in 1815. Within 23 years of their foundation they came to Sydney to minister particularly to the minority of women in the infant colony of New South Wales and specifically to servant girls, convict women and prostitutes.

Inevitably they had their detractors, particularly among the upper echelons of self-righteous colonial society. They were accused of being naive and misguided, that the women to whom their specific ministry was directed were beyond redemption, that the Sisters were being led up the garden path or being misled by experts, no doubt the early equivalent of the St Vincent’s Board of Directors.

The Sisters of Charity are not starry-eyed idealists, nor were they ignorant of the controversial nature of their recent proposed initiative. They and their institutions are only too well versed in the complexities of attempting to control drug addiction and to limit its sad consequences. They have had personal experience at the coal-face in these and associated social problems.

There were always two ethical issues at stake in the debate over a MSIS ‘trial’. The more obvious one concerns the likely effectiveness of the room. Would it really save lives? Would it make illicit drug use easier? Would it increase the chances of rehabilitation? Would it confirm people in their addiction?

The medical community has conducted itself in healthy discourse! Eventually, the Darlinghurst Board of the Sisters of Charity Health Service came to the conclusion that an 18- month trial of an injecting service was well worth undertaking. Indeed, the evidence put to us suggested that 50 young Australians would be alive at the end of the trial who would otherwise be dead in the back streets and alleys of Sydney if the trial did not take place. Further, the St Vincent’s mission to offer compassionate care to our local Darlinghurst community combined with our existing world-class drug and alcohol services made the hospital the obvious partner for the NSW Government’s initiative.

Nevertheless, as a Catholic health care facility, St Vincent’s always recognised a prior ethical question that was most important. Would operation of an injecting service be wrong in principle, quite apart from its likely consequences?

Would the service involve direct participation in activities that are harmful in themselves and which so often occasion further harm to others? This required careful reflection and discernment. It is significant that the Vatican’s instruction to the Sisters of Charity, which the St Vincent’s Board accepted, does not rely on an in-principle objection to an injecting service as such. The instruction does not say that an injecting service is necessarily immoral.

The Vatican’s Congregation of the Faith letter gives little support, therefore, to those critics within the church who have been claiming that ‘harm minimisation’ strategies are never permissible. Rather, Cardinal Ratzinger’s letter refers to some practical considerations – to the messages it believes would be sent to other people (chiefly outside Australia) and to the ‘vigorous debate’ among experts about the likely effects of the service.

Criticisms of the Sisters initiative in terms of ‘misdirected compassion’, and ‘band-aid solutions’ lose their plausibility when considered from the point of view of the victims in the gutter, in public toilets and on the very steps of churches. Can Christians imagine Christ offering similar advice to those who have lost their way? It stretches both imagination and faith. True, Jesus exhorted the wayward to ‘sin no more’ but where in Scripture does he condemn them to suffer the mortal consequences of their weakness because the benefits of practical assistance may be uncertain and the harm done might outweigh these problematic benefits?

The distance between St Peter’s Square and Darlinghurst Road is measured, alas, more in tragedy than in kilometres.

From the outset, the St Vincent’s Darlinghurst Board has recognised the need to operate the service in a way that would avoid sending the wrong signals the Vatican is concerned about. We are disappointed that we have not had the chance to finalise ethical and other protocols for the operation of the service and for the education of its staff – protocols that might have addressed these concerns. They remain in ‘draft’ form and were never asked for by the CDF or anyone else. More the pity. It was never going to be easy to ensure that the injecting service remained true to its stated objectives of assisting people hold onto life and increasing the chances of rehabilitation. Few will deny, however, that corpses cannot be rehabilitated. Of course, difficult questions remain, especially about whether a trial, which does not include young, under-aged drug-users, can be valid or effective.

Nonetheless, there is good reason to think St Vincent’s unwavering commitment to Catholic moral teachings would have increased its chances of running the injecting service in a morally sound way. Those Catholics (the extreme self-appointed ‘inquisitors’ of the Australian Church) who opposed the trial and who, we are told, took the matter to Rome, will be delighted at this outcome, though whether they represent most Catholics, as the Archbishop of Melbourne and member of the CDF has suggested, is a matter for speculation. Judging from letters to the press, a significant number of informed Sydney Catholics in no way share Dr Pell’s position.